Postoperative care for pectus excavatum

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on December 31, 2024
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Pectus excavatum surgery involves implanting a metal plate in the patient's body; however, this type of metal plate cannot be welded to normal bones or muscles. It is only fixable using stainless steel wires or sutures. Therefore, postoperative care is crucial. Good post-surgical care significantly reduces the chances of the metal plate shifting. We recommend that patients lie flat on their backs for 3 to 5 days after the surgery, avoid bending, twisting their bodies, or rolling over in bed for a week. For a month, it's important for patients to keep their bodies straight and stand flush against a wall. Since the chest will be quite painful after the surgery, standing against a wall helps the patient maintain a proper posture. Otherwise, due to the pain, the patient may stoop forward, resulting in a hunched posture, which is unappealing and not good for the spine. Within two months post-surgery, the patient should avoid bending over to lift heavy objects as this can lead to uneven distribution of force that may cause the metal plate to shift. Intense physical activities should be avoided for three months. The patient should ideally rest in a supine position and avoid external injuries and contact or impact sports like basketball, soccer, or football. Generally, the metal plate should be removed 2 to 3 years after the surgery depending on the circumstances, so regular clinic visits are necessary to monitor the situation of the plate. If the patient experiences difficulty breathing or chest pain after being discharged from the hospital, they should immediately go to the nearest hospital to have their chest x-rayed to check the status of the metal plate.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Is pectus excavatum hereditary?

Is pectus excavatum hereditary? According to modern genetic medicine, actually, about 80% of diseases are related to genetics to some extent, and pectus excavatum is no exception. Normally, pectus excavatum occurs in about one in 400 to 1000 people, with a higher prevalence in males. Research has also found that pectus excavatum is often seen in several genetic disorders, including Noonan syndrome, Turner syndrome, and Marfan syndrome. This indicates that it shares certain genes with these genetic disorders, such as the fibrillin-1 gene and others in the RAS/MAPK pathway. These genetic correlations may not always be evident, for example, the parents may not have pectus excavatum themselves. However, when parents with these recessive genes reproduce, their combination might result in pectus excavatum in their child. The development of pectus excavatum might be related to abnormal asymmetrical development of the cartilage. Thus, there is indeed a certain correlation between pectus excavatum and genetic factors.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Can funnel chest be cured?

In fact, many diseases cannot be completely cured, including the common cold, for which there is currently no way to completely eradicate it, meaning there isn't a medicine that, once taken, prevents one from ever catching a cold again. Of course, this has a lot to do with the mutations of the cold virus. However, pectus excavatum can be cured, and there are generally two methods of treatment for it: surgical and non-surgical. The surgical method is suitable for older patients with harder bones. Conservative treatment is appropriate for younger patients with more elastic rib cages, who can cooperate well, or whose family can supervise and support them through this non-surgical approach. Regardless, it is completely possible to cure pectus excavatum, and there are methods to do so.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to exercise the pectoral muscles with pectus excavatum?

How to exercise the pectoral muscles with pectus excavatum, we know that the indentation of pectus excavatum is concave inward and backward, that is, the front sternum in the middle of a person's chest compresses backward towards the spine. Exercising the pectoralis major muscle aims to lift the muscles on both sides of the sternum, but the attachment point of the pectoralis major actually pulls from the ribs outward and upward towards the humeral tuberosity of the arms. This type of lifting actually pulls the force of the ribs or a part of the sternum outward, and it cannot pull forward. Indeed, the forward force is the direction truly needed when correcting pectus excavatum. Therefore, patients with pectus excavatum can exercise the pectoralis major, do push-ups, and perform dumbbell fly exercises, which are all feasible. However, such exercise will only make the pectoral muscles thicker and the force is directed sideways, and it cannot effectively pull the downward and inward-concaved sternum forward. Therefore, although individuals with pectus excavatum can perform exercises like push-ups and dumbbell flies like normal individuals, these exercises should not be expected to significantly improve pectus excavatum. Moreover, current medical technology and trials have not found exercising the pectoralis major to have a substantial corrective effect on pectus excavatum.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Best age for pectus excavatum surgery

The best age for funnel chest surgery, according to the latest and most authoritative ninth edition of the surgical textbook, is between three and five years old. Historically, there has been controversy over the best age for funnel chest surgery, with some pediatricians previously believing it should wait until adolescence. However, it has been found that by the age of five, children start to become more aware and might realize their chest shape differs from others, potentially leading to feelings of inferiority and reluctance to make friends. Thus, performing the surgery before the age of five—before the child is fully aware of their deformity—might actually be preferable, as it could minimize psychological and physiological impacts. Of course, there is also a viewpoint supporting surgery before the age of three, but the younger the child, the softer the chest bone, which sometimes allows for other potential corrective methods.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum should go to which department?

Regarding the registration of patients or children with pectus excavatum, if it is for children and the consultation is only about the hereditary aspect of pectus excavatum or its etiology, consider registering at the pediatrics or child health department. It is also feasible to consult the genetics department. If the consultation is about treatment options for pectus excavatum, including methods of treatment, consider registering at the thoracic surgery department. Thoracic surgery can provide advice and methods for the treatment of pectus excavatum, including both surgical and non-surgical options. Of course, not all hospitals have a thoracic surgery department; generally, municipal third-level, first-class hospitals are equipped with thoracic surgery departments. If there is no thoracic surgery available, consider registering under the general surgery department.